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Informed consent
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==From children== {{Main| Informed assent}} {{See also|Pediatric medicine#Pediatric autonomy in healthcare}}As children often lack the decision-making ability or legal power (competence) to provide true informed consent for medical decisions, it often falls on parents or legal guardians to provide ''informed permission'' for medical decisions. This "consent by proxy" usually works reasonably well, but can lead to ethical dilemmas when the judgment of the parents or guardians and the medical professional differ with regard to what constitutes appropriate decisions "in the best interest of the child". Children who are [[Emancipation of minors|legally emancipated]], and certain situations such as decisions regarding sexually transmitted diseases or pregnancy, or for unemancipated minors who are deemed to have medical decision making capacity, may be able to provide consent without the need for parental permission depending on the laws of the jurisdiction the child lives in. The [[American Academy of Pediatrics]] encourages medical professionals also to seek the assent of older children and adolescents by providing age appropriate information to these children to help empower them in the decision-making process.<ref name="AAP">{{cite journal | author = Committee on Bioethics | year = 1995 | title = Informed consent, parental permission, and assent in pediatric practice | url = http://pediatrics.aappublications.org/content/95/2/314.full.pdf | journal = Pediatrics | volume = 95 | issue = 2| pages = 314β7 | doi = 10.1542/peds.95.2.314 | pmid = 7838658 | s2cid = 22221051 }}</ref> Research on children has benefited society in many ways. The only effective way to establish normal patterns of growth and metabolism is to do research on infants and young children. When addressing the issue of informed consent with children, the primary response is parental consent. This is valid, although only legal guardians are able to consent for a child, not adult siblings.<ref name="Annas, Glantz, Katz 1977 63β93">{{cite book|last1=Annas |first1=George J. |last2=Glantz |first2=Leonard |last3=Katz |first3=Barbara |title=Informed Consent to Human Experimentation|year=1977|publisher=Ballinger Publishing Company|location=Cambridge, Massachusetts|isbn=978-0-88410-147-5|pages=[https://archive.org/details/informedconsentt0000anna/page/63 63β93]|url-access=registration|url=https://archive.org/details/informedconsentt0000anna/page/63}}</ref> Additionally, parents may not order the termination of a treatment that is required to keep a child alive, even if they feel it is in the best interest.<ref name="Annas, Glantz, Katz 1977 63β93"/> Guardians are typically involved in the consent of children, however a number of doctrines have developed that allow children to receive health treatments without parental consent. For example, emancipated minors may consent to medical treatment, and minors can also consent in an emergency.<ref name="Annas, Glantz, Katz 1977 63β93"/> Information provided to parents/guardians, and to children themselves, as part of clinical research is often written in ways that make them difficult to understand. <ref>{{Cite journal |last=Nash |first=Elizabeth |last2=Bickerstaff |first2=Matthew |last3=Chetwynd |first3=Andrew J. |last4=Hawcutt |first4=Daniel B. |last5=Oni |first5=Louise |date=September 2023 |title=The readability of parent information leaflets in paediatric studies |url=https://www.nature.com/articles/s41390-023-02608-z |journal=Pediatric Research |language=en |volume=94 |issue=3 |pages=1166β1171 |doi=10.1038/s41390-023-02608-z |issn=1530-0447|pmc=10444605 }}</ref><ref>{{Cite journal |last=OβHalloran |first=Cian P. |last2=Agarwal |first2=Abhishek |last3=Hawcutt |first3=Daniel B. |last4=Oni |first4=Louise |last5=Moss |first5=James |date=2025-02-22 |title=Readability of paediatric participant information leaflets in research studies |url=https://www.nature.com/articles/s41390-025-03943-z |journal=Pediatric Research |language=en |pages=1β6 |doi=10.1038/s41390-025-03943-z |issn=1530-0447|doi-access=free }}</ref>
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